Should I take a cholesterol-busting ‘Statin’?

 

What are statins?

This is a group of drugs which reduces total cholesterol and in particular the LDL-cholesterol, ‘bad cholesterol’ (as opposed to HDL- cholesterol which is protective). High levels of this, along with other risk factors, increase your risks of developing coronary heart disease.

 

I’ve heard I can now buy this without a prescription?

One of this group of drugs, Simvastatin will shortly be available ‘over the counter’ at the chemist. The pharmacist will need to ask certain questions to find out if you will benefit from this drug; in other words to assess your own individual cardiovascular risks.

If your risks are moderate (a 10-15% chance of a fatal cardiovascular event such as a heart attack over the next 10 years), then the pharmacist will be able to sell you Simvastatin at a dose of 10mg. You will need to take this once a day at least until you are 80 years old to maintain the benefits.

For those assessed at low risk, there is not enough evidence of benefit from taking statins.

For those at high risk you should see your GP.

Don’t forget also, a prescription for a 2 month supply will cost less than 2 months’ worth of over the counter supplies.

 

Are there any side effects?

Simvastatin, like most drugs, possesses a long list of possible effects such as muscle problems, liver problems, gastro-intestinal effects including abdominal pain, flatulence, diarrhoea, nausea and vomiting, headaches, dizziness, hair loss, rashes and hypersensitivity reactions and so on. True, at the allowed small dose of 10mg it is unlikely that many will suffer side effects.

It can, however, interact with some other medication, even some herbal preparations, so you must always inform doctors and pharmacists about everything you are taking.

 

Is it effective?

There is a large body of evidence for the effectiveness of statins, so much so that it is possible in future that everyone over the age of 50 will be recommended a ‘polypill’ which could virtually eliminate coronary heart disease, one of the ingredients being a statin.

Even if you have a ‘normal’ cholesterol level but otherwise are deemed to be at moderate risk of cardiovascular disease, taking a statin to lower your cholesterol further is now known to be beneficial. This is why the Government has decided to allow pharmacists to sell you Simvastatin without even measuring your cholesterol level.

10mg of Simvastatin should lower your LDL-cholesterol by a useful 28% (but this may not be enough if you are at higher risk – you may need a larger dose)

 

What is the ‘right’ cholesterol level?

It seems the lower the better. A total cholesterol level of 6.5mmol/l (one a few years ago we would have accepted as normal) gives double the risk of a heart attack compared to 5mmol/l. The average UK male has a level of 6.2 (women 6.1).

If you have other risk factors, lowering your cholesterol is even more important and higher doses of statins are used to take the total cholesterol below 4.

 

Could I be at risk?

Yes: If you have had any cardiovascular disease (angina, heart attack, coronary artery disease), if you have first degree relatives (parents, siblings) who had premature cardiovascular disease (under the age of 65) or familial hyperlipidaemia (high cholesterol and or triglycerides), if you smoke, have diabetes or high blood pressure. Being male and of increasing age makes you more at risk.

 

To calculate your own cardiac risks click here

 

Are statins the whole answer?

No, they will help but properly reducing your risks involves many other permanent changes to your life: the single most important being that you must stop smoking. You should take regular exercise, eat a good diet, ensure your blood pressure is normal, that you don’t have related problems such as diabetes or thyroid disorders, your weight is good and you don’t drink too much alcohol.

 

Shouldn’t I be consulting my doctor?

Doctors are certainly worried about this policy by the government and think it might confuse matters. Many think cynically that it is simply a headline grabbing move designed to reduce the rapidly accelerating drug budget and induce a false sense of security in certain individuals.

Concerns include:

l that people most in need will not get the treatment (the well known inverse-care law) and it may lull others into a false sense of security, preventing them tackling more important issues

l it could be the wrong dose (the evidence now suggests that doctors should start Simvastatin at 40mg, certainly in those at higher risk)

l that the full cardiac risk will not be assessed (a proper differential lipid blood test should be taken, other blood tests taken to check you don’t have diabetes or diseases of your  kidneys, liver, thyroid and so on, blood pressure should be measured, body mass index calculated etc)

l that the medical records will be unavailable (what other lifestyle factors or important past medical conditions might need to be factored in, what other potential drug interactions might occur?)

l that risk factor reduction involves many more factors than just taking a small dose of Simvastatin – all the factors mentioned above

l that we may be unaware of our patients taking a statin and may prescribe a drug which conflicts, causing potentially serious side effects

l that our patients won’t be properly monitored and their risks optimised

 

So if I come to the GP what happens?

We assess your risks by consulting your records, asking you some questions about your family and your lifestyle, performing some basic examinations and blood tests and feed information into our computer risk calculator. We take an overview and discuss with you the most useful interventions to improve your cardiovascular health, among which might be to start a statin at an appropriate dose. We then arrange to reassess you at regular intervals to ensure you remain well and healthy long into the future.

 

What next?

For an assessment and discussion of your cardiovascular risks, make an appointment with one of our practice nurses or your GP.

 

More Information

For more information about coronary heart disease click the following links:

 Webhealth (for a good overview)

Family Heart Association (for more detail including excellent downloadable fact-sheets)

The Coronary Prevention Group.

 

For more information about cholesterol and cholesterol reduction click here

 

For full details about statins from the doctors’ drug handbook the ‘BNF’ click here (go to section 2.12).

 

 

This information sheet was prepared by Willow Tree Family Doctors to help their patients make informed choices.